Telemedicine platforms under growing scrutiny as GLP-1 prescriptions rise

One in eight adults reported using a GLP-1 drug for weight loss or another health condition, according to a KFF Health Tracking Poll published last year. As demand surged, these drugs became in short supply beginning in 2022. Shortages of semaglutide and tirzepatide paired with the high cost of brand name GLP-1s created barriers to access.  

In response to the shortages, the Federal Drug Administration (FDA) allowed compounding pharmacies to step in to help meet market demand. Many telemedicine platforms seized the opportunity to offer compounded versions of name brand GLP-1s at a lower cost.   

The semaglutide and tirzepatide shortages are now resolved, but telemedicine platforms remain a significant access point for GLP-1s, offering patients the convenience of getting a prescription online and, often, having the medication shipped right to their door. But the FDA and drug companies are raising concerns about how some telemedicine companies are marketing and prescribing weight loss drugs.   

Increasing scrutiny 

The FDA does not approve compounded drugs, and the federal agency is keeping an eye on the way that telemedicine companies market compounded GLP-1 products. In March, it announced that it sent warning letters to 30 companies regarding “false or misleading claims” in their direct-to-consumer advertisements. Telemedicine companies are attracting that regulatory attention for issues such as claiming compounded drugs are FDA-approved or claiming compounded drugs are clinically proven to deliver the same results as FDA-approved drugs.  

The warning letters are part of the FDA’s ongoing crackdown; it has sent thousands of warning letters to telemedicine and pharmaceutical companies regarding misleading ads in recent months.  

“No one’s getting major fines. No one’s getting shut down from just those warning letters to start. They give the industry a chance to change, to comply,” Thomas Ferrante, a partner with global law firm Foley & Lardner and a member of the American Telemedicine Association’s (ATA) Policy Council, said.  

In addition to scrutiny from the FDA, some telemedicine platforms and compounding pharmacies are being drawn into legal battles with drug companies. Last year, Eli Lilly sued telemedicine companies Fella Health, Henry Meds, Mochi Health and Willow Health, which sell compounded versions of its GLP-1 drugs Mounjaro and Zepbound. Eli Lilly is accusing the telemedicine platforms of “deceiving consumers,” CNBC reported.  

Novo Nordisk filed a patent infringement lawsuit against Hims & Hers earlier this year. It ended up dropping the lawsuit and striking a partnership with the telemedicine company. Hims & Hers will now offer Novo Nordisk’s Wegovy and Ozempic on its platform, and it will stop marketing compounded GLP-1s, according to PBS.  

But marketing tactics and accusations of patent infringement aren’t the only reason telemedicine companies are drawing attention. The FDA has noted safety concerns regarding compounded GLP-1s and telemedicine companies. It has received complaints that some compounded GLP-1 drugs have had quality issues due to insufficient refrigeration. It also noted awareness of fraudulent compounded drugs and dosing errors that led to adverse patient events.  

Some telemedicine platforms are also drawing criticism for operating with asynchronous models and not providing necessary clinical support after prescribing GLP-1s.  

“Some of those online platforms, I think, are a little aggressive. There’s almost no clinical interaction. There’s no follow-up,” Ferrante said. “Things can be done asynchronously, but it doesn’t mean you abandon that clinical standard of care.” 

How oversight could change  

As a result of the COVID-19 pandemic, states relaxed many of their telemedicine regulations, resulting in a significant expansion of these services. The Centers for Medicare and Medicaid Services (CMS) extended several Medicare telehealth flexibilities through 2027. While the market for virtual care has grown, these platforms are still subject to federal and state regulation.  

For example, the Ryan Haight Act dictates how telemedicine providers can prescribe controlled substances. State level regulations also address issues like prescribing, provider licensing and reimbursement. Thus far, policy has not targeted GLP-1 drugs in particular, according to Mei Wa Kwong, JD, executive director of the Center for Connected Health Policy, a nonprofit focused on telehealth policy.  

“GLP-1s are not controlled substances,” she said. “They don’t have to follow those federal regulations that controlled substances do.” 

But Kwong noted that different states do have specific carve-out policies for online prescribing of some non-controlled drugs and devices. 

“For example, certain drugs for reproductive services, hearing aids, contact lenses, those types of things, do have specific laws in some states on how they’re to be prescribed if telehealth is being used to prescribe them.” Kwong said. “That might be something in the future for GLP-1 drugs if that concern continues to be elevated.” 

Carrie Pallardy, a Chicago-based freelance writer and editor, began her career covering healthcare more than a decade ago. Her work has taken into many different industries, but covering healthcare delivery remains a constant focus. She can be reached at [email protected] or on LinkedIn.